Your Rheumatoid Arthritis Diet 3 Nutrients You Need for RA Treatment

When you have rheumatoid arthritis, it’s tough to get all the nutrition you need. Prescription medications may interfere with your body’s ability to absorb nutrients. Plus, rheumatoid arthritis pain can turn cooking into a grueling chore. Here, top experts weigh in on 3 key vitamins and minerals for a healthy rheumatoid arthritis diet, and the best ways to get them… If you have rheumatoid arthritis (RA), a healthful diet is especially important because the autoimmune disease, which causes the body to attack its own tissue, leaves patients vulnerable to nutritional deficiencies. For example, rheumatoid arthritis pain and discomfort can make cooking a challenge. And some common RA medications may hamper your body’s ability to absorb important nutrients. “All these issues contribute to increased nutritional imbalances over time,” says Meenakshi Jolly, M.D., director of the Rush Lupus Clinic and associate program director of rheumatology at Chicago’s Rush University Medical Center. The best way to ensure a healthy rheumatoid arthritis diet is to enjoy foods rich in lean proteins, whole grains, fruits and vegetables, she says. But if you have RA and take medications such as steroids and NSAIDS, you may have digestive problems and not eat properly. If you don’t – or can’t – eat a varied, nutritious rheumatoid arthritis diet, you may need supplements, says Stephen L. Burnstein, D.O., a board-certified rheumatologist and clinical professor at the University of Medicine and Dentistry of New Jersey. “In that case, a multivitamin would be helpful,” he says. The following three nutrients are especially important for women with RA. Here’s how to get enough of them. 1. Folic Acid for Red Blood Cells If you take methotrexate, a drug routinely prescribed for rheumatoid arthritis treatment, you may need to boost your folic-acid intake. That’s because methotrexate reduces your body’s ability to absorb this B vitamin. (However, it doesn’t have that effect on other B vitamins, Burnstein says.) The body needs folic acid to make red blood cells, which transport oxygen from the lungs. If you don’t get enough, you may develop anemia and fatigue, Jolly warns. “People on methotrexate should take a multivitamin with folic acid, or 1-2 milligrams (mg) of folic acid as a supplement [on its own],” Burnstein advises. Your doctor probably will prescribe or recommend folic acid along with methotrexate. But since the two compete with each other in the body, it’s best not to take them at the same time. “Methotrexate is taken once a week, so women should take the [B] vitamin on the [other] days, when they’re not on the drug,” Jolly says. Getting sufficient amounts of folic acid in a rheumatoid arthritis diet is especially important for women with RA who may become pregnant, because it’s necessary for normal fetal development, Burnstein says. A deficiency may result in spina bifida, a serious fetal defect in which the backbone and spinal canal don’t close before birth. But you may not even need rheumatoid arthritis treatment during pregnancy, Burnstein says. “Many times, the disease goes into remission during pregnancy, and no medications are necessary,” Burnstein says. Why remission happens is unknown – and symptoms of rheumatoid arthritis usually return after delivery, he adds. Don’t take methotrexate during pregnancy without consulting your doctor. Using the medication during the first trimester raises the risk of spina bifida and brain defects six-fold, according to a 2009 study published in the British Journal of Clinical Pharmacology. Daily requirement: 400 micrograms (mcg) – unless you’re on a medication such as methotrexate. Then check with your doctor. Get it from: Federal law requires manufacturers to add folic acid to cold cereals, flour, breads, pasta, bakery items, cookies and crackers, so most healthy people get enough in their diets normally. Enriched cereals, pastas and breads vary in the amount of folic acid per serving, so check the Nutrition Facts before buying. Nearly all fortified cereals, including Wheat Chex and General Mills Raisin Bran, contain 400 mcg of folic acid per serving. You’ll also get folic acid from leafy green vegetables, such as spinach, broccoli and lettuce, as well as asparagus, bananas, melons, beans, mushrooms, oranges and tomato juice. A cup of raw spinach contains 60 mcg, for example, while four asparagus spears have 85 mcg. Surprisingly, folic acid that occurs naturally in food isn’t absorbed as efficiently as synthetic forms. So even if you eat lots of veggies on your rheumatoid arthritis diet, you may also need to eat fortified foods or take a vitamin. 2. Calcium and Vitamin D for Strong Bones Steroids commonly used to control RA inflammation may put you at risk for osteoporosis (thinning of bone tissue and loss of bone density). That’s because the drugs inhibit the body’s natural bone-renewal process. Plus, joint pain and limited range of motion often keep women with RA from doing weight-bearing exercise, which can boost bone mass. “Women who are inactive due to RA have an increased risk of osteoporosis,” Burnstein warns. All of this makes adequate calcium and vitamin D – nutrients needed to build and maintain strong bones – even more important in a rheumatoid arthritis diet. Too little vitamin D may even increase your risk of developing RA symptoms in the first place, according to a 2010 Boston University study. Women who lived in Northern areas with limited sun exposure – and who had naturally lower vitamin-D levels – were more likely to develop RA, researchers found. Daily requirement: The National Osteoporosis Foundation recommends 1,000 mg calcium if you’re under 50; 1,200 mg if you’re over 50. For vitamin D, get 400-800 International Units (IU) up to 50; 800-1,000 IU over 50. Get it from: Dairy products are a good source of calcium for a rheumatoid arthritis diet. An 8-ounce glass of skim milk has 35% of your daily requirement. Other calcium options include dark green leafy vegetables, sardines, wild salmon and calcium-added foods like tofu or fortified orange juice. You absorb some vitamin D from sunlight, especially on bright summer days – but it can be hard to know if you’re getting enough. (Your doctor can give you a blood test to determine your vitamin-D levels.) Even foods highest in the vitamin may not add up to the recommended levels. If you don’t get enough with your rheumatoid arthritis diet, taking a multivitamin or a vitamin D supplement can make up the difference. (For more information, read Are You Deficient in Vitamin D?) 3. Protein for Resilient Muscles RA’s chronic inflammation increases production of cytokines, molecules that control inflammatory responses. That increases your body’s metabolic rate, which breaks down healthful proteins. “Protein levels decrease, which we can measure by a test for levels of albumin [proteins found in the blood],” Jolly says. Daily requirement: 50-175 grams (10%-35% of a 2,000-calorie diet). Get it from: Lean meats and poultry, fish, beans, soy, low-fat or fat-free dairy, eggs, nuts and seeds are ideal sources for a rheumatoid arthritis diet. For example, a 3-ounce serving of roasted chicken breast has 27 grams. For more expert advice and information, visit our Rheumatoid Arthritis Health Center. How Much Do You Know About the Types of Arthritis? About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030.